SOP Manual for Direct Health and Medical Insurance Carriers



This industry comprises primarily engaged in initially underwriting health and medical insurance policies. Group hospitalization plans and HMO establishments that provide health and medical insurance policies without providing health care services are included in this industry.

List of Globally Popular Health and Medical Insurance Companies and their countries

CVS Health Corporation - United States, United Health Group Inc - United States, McKesson Corporation - Canada, Amerisource Bergen Corporation - United Kingdom, Cigna Corporation - United States, Cardinal Health Inc - United States, HDFC Health Insurance Company - Mumbai, Star Health and Insurance Company - Chennai, Bajaj Allianz Insurance Company - Pune, National Insurance Company - Kolkata, Tokio General Insurance Company - Gurugham, Oriental Insurance Company - New Delhi, MetLife - New York, Max Bupa Health Insurance Company - New Delhi, Religare Health Insurance Company - Gurgaon, ICICI Lombard Insurance Company - Mumbai.

The following are some of the top critical issues faced by the Health Insurance Companies. 

  • Third Party Administrators
  • Uninsured population is large and growing
  • Rise in Health care costs
  • Health Insurance are not affordable for many people
  • Sudden Hike in renewal Premiums
  • Increasing demand for quality health care
  • Health insurance policy issues
  • Lack of reliable infrastructure

The analysis shows that the functioning of the health insurance company is neither desirable nor sustainable. The private standalone health insurers appear to be over charging its consumers. The government related health companies suffer from financial fragility. Health insurance consumers often complaint about the rejection of legitimate claims by insurance companies, lack of information about network hospitals, use of wrong technical terms, and the differences between the advertised product and the actual product.

Some of the International Organization related to Health Insurance Companies,

  • America’s Health Insurance Plan (AHIP) - ahip.org
  • National Association of Insurance Commissioners (NAIC) -naic.org
  • Health Care Service Corporation (HCSC) - hcsc.com
  • Hospital Contribution Fund (HCF) - hcf.com
  • Vhi Health-care (VHI) - vhi.ie
  • Nib Health Insurance (NIB) - nib.com

Various Industry Standards will be followed by each specific Health Insurance Companies to maintain their reputation.

  • The Emergency Risk Insurance Act, 1971
  • The Securities and Health Insurance Laws Act, 2012
  • Insurance Regulatory and Development Authority Act, 1999
  • General Insurance Act, 1972
  • Health Insurance Act, 1938
  • Patient Protection and affordable care Act, 2010
  • Health Insurance portability and accountability Act, 2014

The insurance industry uses analytic for all sorts of insurance products such as life, property, health care, unemployment etc. Health Insurance Penetration in India has reached 3.67% from 2.71%. Digital Technology will increase the number of users to rise from 429 million to 829 million at the rate of 17.9%. In 2011, 3.9% of GDP was spent in health sector. Out of this, 5-10% of expenditure, employers account for around 9% while personal expenditure amounts to 82%. 20% reduction has been allowed for the senior citizen from the total payment on major illness. There are over 4300 network of hospitals around the world.

Some of the Magazines that will keep you on track

  • Health-tech Magazine
  • Insights Care
  • Health-care Global
  • Health-care Design Magazine
  • Hospital and Health care management
  • Health Business
  • Behavioral Health-care Magazine


Written by Bharath Ravi

Business Consultant whose qualification includes a Bachelor’s degree in the field of Mechanical specialized in Automobile & Manufacturing; Trained in Certified Supply Chain Professional (CSCP) Certification, Hands on Foundation Certificate in Business Analysis, BCS (UK) and Certified Professional for Requirements Engineering (CPRE-FL).

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